Female Veterans' Willingness to Seek Veterans Health Administration and Non-Veterans Health Administration Services for Suicidal Thoughts and Mental Health Concerns.
Adult
Aged
Cross-Sectional Studies
Facilities and Services Utilization
Female
Help-Seeking Behavior
Humans
Mental Health Services
Middle Aged
Patient Acceptance of Health Care
/ statistics & numerical data
Surveys and Questionnaires
United States
Veterans
/ psychology
Veterans Health Services
Women
/ psychology
Suicide Prevention
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 02 2021
01 02 2021
Historique:
entrez:
13
1
2021
pubmed:
14
1
2021
medline:
7
4
2021
Statut:
ppublish
Résumé
The extent to which female veterans are willing to seek Veterans Health Administration (VHA) and non-VHA care when they are suicidal or experiencing mental health (MH) concerns is unknown. The objectives of this study were to: (1) examine whether current, past, and never VHA using female veterans' willingness to seek VHA care differs from their willingness to seek non-VHA care if suicidal or experiencing MH symptoms; (2) examine if VHA use, military sexual trauma, and suicidal ideation and attempt are associated with female veterans' willingness to use VHA and non-VHA care when experiencing suicidal thoughts or MH symptoms. A cross-sectional anonymous survey. Four hundred thirty nine female veterans, including current, past, and never VHA users were included. General Help-Seeking Questionnaire, Self-Injurious Thoughts and Behaviors Interview, and the VA Military Sexual Trauma Screening Questions. Current VHA users reported more willingness to use VHA than non-VHA care; conversely, past and never VHA users reported less willingness to use VHA care relative to non-VHA care. Military sexual assault and none or past VHA use were associated with lower willingness to use VHA care if suicidal or experiencing MH symptoms. In contrast, those with none or past VHA use reported greater willingness to use non-VHA care if suicidal or experiencing MH symptoms, while prior suicide attempt was associated with lower willingness. Ensuring that acceptable and effective suicide prevention services are available to female veterans in both VHA and community settings is critical. Increasing help-seeking intentions among female veterans who have attempted suicide or experienced military sexual assault is also essential.
Sections du résumé
BACKGROUND
The extent to which female veterans are willing to seek Veterans Health Administration (VHA) and non-VHA care when they are suicidal or experiencing mental health (MH) concerns is unknown.
OBJECTIVES
The objectives of this study were to: (1) examine whether current, past, and never VHA using female veterans' willingness to seek VHA care differs from their willingness to seek non-VHA care if suicidal or experiencing MH symptoms; (2) examine if VHA use, military sexual trauma, and suicidal ideation and attempt are associated with female veterans' willingness to use VHA and non-VHA care when experiencing suicidal thoughts or MH symptoms.
RESEARCH DESIGN
A cross-sectional anonymous survey.
SUBJECTS
Four hundred thirty nine female veterans, including current, past, and never VHA users were included.
MEASURES
General Help-Seeking Questionnaire, Self-Injurious Thoughts and Behaviors Interview, and the VA Military Sexual Trauma Screening Questions.
RESULTS
Current VHA users reported more willingness to use VHA than non-VHA care; conversely, past and never VHA users reported less willingness to use VHA care relative to non-VHA care. Military sexual assault and none or past VHA use were associated with lower willingness to use VHA care if suicidal or experiencing MH symptoms. In contrast, those with none or past VHA use reported greater willingness to use non-VHA care if suicidal or experiencing MH symptoms, while prior suicide attempt was associated with lower willingness.
CONCLUSIONS
Ensuring that acceptable and effective suicide prevention services are available to female veterans in both VHA and community settings is critical. Increasing help-seeking intentions among female veterans who have attempted suicide or experienced military sexual assault is also essential.
Identifiants
pubmed: 33438879
doi: 10.1097/MLR.0000000000001480
pii: 00005650-202102001-00009
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
S23-S30Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Department of Veterans Affairs. 2019 National Veteran Suicide Prevention Annual Report; 2019. Available at: www.mentalhealth.va.gov/docs/data-sheets/2019/2019_National_Veteran_Suicide_Prevention_Annual_Report_508.pdf . Accessed February 28, 2020.
Department of Veterans Affairs. VA National Suicide Data Report 2005–2015; 2018. Available at: www.mentalhealth.va.gov/docs/data-sheets/2015/OMHSP_National_Suicide_Data_Report_2005-2015_06-14-18_508.pdf . Accessed February 25, 2020.
Department of Veterans Affairs. 2017 National Suicide Data Appendix; 2019. Available at: https://www.mentalhealth.va.gov/docs/data-sheets/2017/2005-2017_National_Data_Appendix.xlsx . Accessed February 25, 2020.
Department of Veterans Affairs. National Strategy for Preventing Veteran Suicide 2018–2028; 2018. Available at: www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-Health-and-Suicide-Prevention-National-Strategy-for-Preventing-Veterans-Suicide.pdf . Accessed February 28, 2020.
Franklin K. National suicide strategy. Fed Pract. 2019;36:107–109.
US Government. Executive order on a national roadmap to empower veterans and end suicide; 2019. Available at: www.whitehouse.gov/presidential-actions/executive-order-national-roadmap-empower-veterans-end-suicide/ . Accessed February 28, 2020.
Mann JJ, Apter A, Bertolote J, et al. Suicide prevention strategies: a systematic review. JAMA. 2005;294:2064–2074.
Hom MA, Stanley IH, Joiner TE Jr. Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: a review of the literature. Clin Psychol Rev. 2015;40:28–39.
Danan ER, Krebs EE, Ensrud K, et al. An evidence map of the women veterans’ health research literature (2008–2015). J Gen Intern Med. 2017;32:1359–1376.
US Government. Veterans’ benefits: counseling and treatment for sexual trauma, 38 USC §1720D; 2014. Available at: www.gpo.gov/fdsys/pkg/USCODE-2014-title38/pdf/USCODE-2014-title38-partII-chap17-subchapII-sec.1720D.pdf . Accessed February 28, 2020.
Ouimette P, Wolfe J, Daley J, et al. Use of VA health care services by women veterans: findings from a national sample. Women Health. 2003;38:77–91.
Washington DL, Bean-Mayberry B, Riopelle D, et al. Access to care for women veterans: delayed healthcare and unmet need. J Gen Intern Med. 2011;26:656–661.
Surís A, Lind L. Military sexual trauma: a review of prevalence and associated health consequences in veterans. Trauma Violence Abuse. 2008;9:250–269.
Monteith LL, Holliday R, Hoyt T, et alKumar U. Military sexual trauma and suicidal self-directed violence: a narrative review and proposed agenda for future research. The Routledge International Handbook of Military Psychology and Mental Health. Oxfordshire, UK: Routledge; 2019:411–424.
Wilson LC. The prevalence of military sexual trauma: a meta-analysis. Trauma Violence Abuse. 2018;19:584–597.
Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide, Version 2.0; 2019. Available at: www.healthquality.va.gov/guidelines/MH/srb/VADoDSuicideRiskFullCPGFinal5088212019.pdf . Accessed February 28, 2020.
Wortzel HS, Homaifar B, Matarazzo B, et al. Therapeutic risk management of the suicidal patient: stratifying risk in terms of severity and temporality. J Psychiatr Pract. 2014;20:63–67.
Han B, Compton WM, Gfroerer J, et al. Mental health treatment patterns among adults with recent suicide attempts in the United States. Am J Public Health. 2014;104:2359–2368.
Choi NG, DiNitto DM, Marti CN. Mental health treatment use and perceived treatment need among suicide planners and attempters in the United States: between and within group differences. BMC Res Notes. 2015;8:305.
Hom MA, Albury EA, Gomez MM, et al. Suicide attempt survivors’ experiences with mental health care services: a mixed methods study. Prof Psychol Res Pract. 2019;51:172–183.
Blanchard M, Farber BA. “It is never okay to talk about suicide”: patients’ reasons for concealing suicidal ideation in psychotherapy. Psychother Res. 2020;30:124–136.
Monteith LL, Holliday R, Miller C, et al. Suicidal ideation, suicide attempt, and non-suicidal self-injury among female veterans: prevalence, timing, and onset. J Affect Dis. 2020;273:350–357.
Wilson CJ, Deane FP, Ciarrochi J, et al. Measuring help-seeking intentions: properties of the General Help Seeking Questionnaire. Can J Couns. 2005;39:15–28.
Blais RK, Renshaw KD. Stigma and demographic correlates of help‐seeking intentions in returning service members. J Trauma Stress. 2013;26:77–85.
Teo AR, Marsh HE, Liebow SB, et al. Help-seeking on Facebook versus more traditional sources of help: cross-sectional survey of military veterans. J Med Internet Res. 2018;20:e62.
Nock MK, Holmberg EB, Photos VI, et al. Self-Injurious Thoughts and Behaviors Interview: development, reliability, and validity in an adolescent sample. Psychol Assess. 2007;19:309–317.
Perneger TV. What’s wrong with Bonferroni adjustments. BMJ. 1998;316:1236–1238.
Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1:43–46.
Ilgen MA, Bohnert AS, Ignacio RV, et al. Psychiatric diagnoses and risk of suicide in veterans. Arch Gen Psychiatry. 2010;67:1152–1158.
Bohnert KM, Ilgen MA, Louzon S, et al. Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration. Addiction. 2017;112:1193–1201.
US Congress. Female Veteran Suicide Prevention Act; 2016. Available at: www.congress.gov/bill/114th-congress/house-bill/2915?q=%7B%22search%22%3A%5B%22Female+Veteran+Suicide+Prevention+Act%22%5D%7D . Accessed February 28, 2020.
Bryan CJ, Bryan AO, Rozek DC, et alButton ME, Marsh I. Availability and quality of mental healthcare services for veterans at risk for suicide. Suicide and Social Justice: New Perspectives on the Politics of Suicide and Suicide Prevention. New York, NY: Routledge; 2020:180–196.
Monteith LL, Holliday R, Brostow DP, et alKumar U. Understanding suicide among female veterans: a theory-driven approach. The Routledge International Handbook of Military Psychology and Mental Health. Oxfordshire, UK: Routledge; 2019:411–424.
Gradus JL, Suvak MK, Wisco BE, et al. Treatment of posttraumatic stress disorder reduces suicidal ideation. Depress Anxiety. 2013;30:1046–1053.
Kumpula MJ, Wagner HR, Dedert EA, et al. An evaluation of the effectiveness of evidence-based psychotherapies for depression to reduce suicidal ideation among male and female veterans. Womens Health Issues. 2019;29(suppl 1):S103–S111.
Lemle RB. Choice program expansion jeopardizes high-quality VHA mental health services. Fed Pract. 2018;35:18–24.
Than C, Chuang E, Washington DL, et al. Understanding gender sensitivity of the health care workforce at the Veterans Health Administration. Womens Health Issues. 2020;30:120–127.
Meyer EG, Wynn GHRoberts LW, Warner CH. The importance of US military cultural competence. Military and Veteran Mental Health. New York, NY: Springer; 2018:15–33.
Ganzini L, Denneson LM, Press N, et al. Trust is the basis for effective suicide risk screening and assessment in veterans. J Gen Intern Med. 2013;28:1215–1221.
Sheehan L, Oexle N, Armas SA, et al. Benefits and risks of suicide disclosure. Soc Sci Med. 2019;223:16–23.
Ramchand R, Ayer L, Kotzias V, et al. Suicide risk among women veterans in distress: perspectives of responders on the Veterans Crisis Line. Womens Health Issues. 2016;26:667–673.
Foynes MM, Makin-Byrd K, Skidmore WC, et al. Developing systems that promote veterans’ recovery from military sexual trauma: recommendations from the Veterans Health Administration national program implementation. Mil Psychol. 2018;30:270–281.
Klap R, Darling JE, Hamilton AB, et al. Prevalence of stranger harassment of women veterans at Veterans Affairs medical centers and impacts on delayed and missed care. Womens Health Issues. 2019;29:107–115.
Monteith LL, Bahraini NH, Gerber HR, et al. Military sexual trauma survivors’ perceptions of Veterans Health Administration care: a qualitative examination. Psychol Serv. 2018;17:178–186.
Holliday R, Monteith LL. Seeking help for the health sequelae of military sexual trauma: a theory-driven model of the role of institutional betrayal. J Trauma Dissociation. 2020;20:340–356.
Gaeddert LA, Schneider AL, Miller CN, et al. Recruitment of women veterans into suicide prevention research: improving response rates with enhanced recruitment materials and multiple survey modalities. Res Nurs Health. 2020;43:538–547.
National Center for Veterans Analysis and Statistics. Profile of veterans: 2017; March 2019. Available at: www.va.gov/vetdata/docs/SpecialReports/Profile_of_Veterans_2017.pdf . Accessed September 20, 2020.
National Center for Veterans Analysis and Statistics. The Past, present and future of women veterans; February 2019. Available at: www.va.gov/vetdata/docs/specialreports/women_veterans_2015_final.pdf . Accessed September 20, 2020.
Patten E, Parker K. Women in the US military: growing share, distinctive profile. 2011. Available at: www.pewresearch.org/wp-content/uploads/sites/3/2011/12/women-in-the-military.pdf . Accessed September 20, 2020.
Hammer JH, Spiker DA. Dimensionality, reliability, and predictive evidence of validity for three help-seeking intention instruments: ISCI, GHSQ, and MHSIS. J Couns Psychol. 2018;65:394–401.